Looking through the patient’s chart, an infection-control
consultant at the National Institutes of Health noticed something
troubling.

The patient, a 43-year-old woman from New York, was scheduled
to be admitted to NIH’s Clinical Center, a research hospital for people
enrolled in clinical studies and drug trials, in June 2011.

The patient had a rare lung disease, but the consultant spotted
another problem, one that was potentially even more serious: She had been
colonized by a dangerous, drug-resistant bacterium the likes of which the
Clinical Center had never seen before. It was called KPC
klebsiella.

Klebsiella itself is an ordinary bug, one of many bacteria that
reside in our intestines. But bacteria can exchange genetic code with each
other, and this particular strain of klebsiella had acquired a molecule of
DNA known as KPC.

The KPC molecule deactivates carbapenem, an antibiotic that’s
the drug of last resort for bacterial infections. For severely ill
patients, such as many of those at the Clinical Center, the most likely
result of a KPC-klebsiella bloodstream infection is death.

The job of keeping the bug from spreading to other patients
fell mainly to Tara Palmore, the Clinical Center’s deputy hospital
epidemiologist. Although Palmore and other administrators were nervous
about the patient’s arrival, they believed they could contain the
bacterium and prevent an outbreak.

Palmore followed a strict protocol, outlined by the Centers for
Disease Control and Prevention (CDC): Everyone entering the patient’s room
was required to wear protective gloves and gowns. Caregivers were told to
use disposable products whenever possible. These measures, known as
“enhanced contact isolation” would be maintained both in the ICU and later
in the patient’s room.

The patient arrived on June 13, 2011. She spent 24 hours in the
ICU, then was transferred to a private room. Later that month, she
returned briefly to the ICU, again under enhanced isolation. Afterward,
groin and throat cultures were collected from other ICU patients; none
tested positive. On July 15, five weeks after the patient checked into the
Clinical Center, she was discharged. The testing continued for another
week. All results were negative. It seemed the hospital was in the
clear.

Then, on August 5, Palmore got a call from Adrian Zelazny, head
of the microbiology lab. A 34-year-old male cancer patient in the ICU had
developed an infection. It was KPC klebsiella.

Palmore was puzzled. The cancer patient had never overlapped in
the ICU with the first colonized patient. Was this a new, independent
infection, or had the bacterium found a way to hide, undetected, in the
hospital for weeks before spreading to other patients? The microbiology
lab could say only that the two strains were similar.

Ten days later, a third patient, a 27-year-old woman, tested
positive. Within months, both the second and third patients would die from
sepsis brought on by the infection. (NIH declined to provide patient names
for this story, citing privacy concerns.)

And that was just the beginning. Before the outbreak was
over—if it was over—seven other patients would die. “The system broke,”
says Dr. John Gallin, director of the Clinical Center. “Something went
wrong.”

But this isn’t a story about wrongdoing. It would be reassuring
if it were.

For four months, the staff at NIH mounted an extraordinary
effort to contain the outbreak, one that involved both old-fashioned,
epidemiological detective work and cutting-edge genomic science. The story
of that response—and how doctors and scientists at one of the world’s most
advanced medical facilities were bested by a microscopic
organism—illustrates the dangers we face as we edge closer to a future in
which antibiotics no longer reliably work.

• • •

At the Clinical Center’s groundbreaking in 1951, President
Harry Truman declared victory over the terrible infectious diseases of his
childhood—typhoid, diphtheria, tuberculosis, and pneumonia. “It is safe to
say that we have successfully conquered the infectious diseases,” he
said.

He was wrong. Infections in medical facilities now kill some
99,000 Americans a year—more than three times the number of lives lost
every year to car accidents or gun violence. That’s roughly the equivalent
of a fully loaded 737 jet crashing every day and killing every passenger.
Check into a hospital and there’s a 5-percent chance you’ll acquire an
infection. If you do, there’s a 6.5-percent chance you’ll die as a
result.

By overprescribing antibiotics for ourselves and the animals we
eat, we humans have done something foolish—we’ve waged a war on microbes
that has only made them stronger. According to the CDC, more than 70
percent of the bacteria involved in hospital-acquired infections now have
at least some resistance to antibiotics. And the problem is getting
worse.

In March, Dr. Thomas Frieden, head of the CDC, warned of the
dangers posed by KPC klebsiella and other drug-resistant bacteria. “It’s
not often that our scientists come to me to say that we have a very
serious problem and we need to sound an alarm,” Frieden said on a
conference call, “but that’s exactly what we’re doing today.”

Frieden described “nightmare bacteria” that posed a triple
threat: “First, they’re resistant to all or nearly all antibiotics, even
some of our last-resort drugs. Second, they have high mortality rates.
They kill up to half of people who get serious infections with them. And
third, they can spread their resistance to other bacteria.”

That last point is perhaps the most alarming. Think of KPC as a
code that gives bacteria resistance to the last class of antibiotics we
have that can stop infections—a code that klebsiella can share with other,
more common bacteria. That means, Frieden said, “that we have only a
limited window of opportunity to stop this infection from spreading to the
community and spreading to more organisms.”

Beyond that window, things start to look pretty scary. “We have
eight years until 15 percent of the people who come to us have serious
infections that we will not have treatments for,” says Dr. Allison McGeer,
an infectious-disease epidemiologist at Mount Sinai Hospital in Toronto,
which confronted the first SARS outbreak in North America ten years
ago.

“Right now, if you get a urinary-tract infection, the doctor
pats you on the head and gives you an antibiotic,” says Dr. Brad
Spellberg, an infectious-disease expert at UCLA. “People don’t die of
urinary-tract infections. They are going to start to.”